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The Nathan Littauer Hospital Primary/Specialty Care Center in Perth is shown Wednesday. The hospital says its proximity to the Capital Region has a positive effect on recruitment of doctors.

Schone said the doctors of the current generation are seeking more of a balance between their work and home lives. He said doctors who used to work 70 per hours per week are now looking to work a 40-hour work week.

"We're aware of that," Schone said. "We're trying to respond by offering physicians the opportunity for employment and to make sure we have good balance in our environment."

About 65 percent of the hospitals that responded to the HANYS survey indicate the number of directly employed physicians has increased over the past three years. The same percentage expects one-third and two-thirds of their physicians to be directly employed within the next three years.

Over the past several years, both St. Mary's and Nathan Littauer Hospital have opened satellite offices away from the hospital's main location. For both, the doctors who work at those primary or specialty care centers are all employed directly by the hospital.

Both Schone and Susan Kiernan, the vice president of development at Nathan Littauer Hospital, said direct employment by a hospital frees doctors from having to practice the business of medicine.

In the 18 years Kiernan has worked at the hospital, she said the hospital has gone from employing about one or two doctors, to 40 now, not including mid-level practitioners.

"As physicians come into the area, they want to do what they were trained to do - provide patient care," Kiernan said.

Schone said physicians are moving away from private practice and to more employment by larger or multi-specialty groups.

"If somebody comes to town and establishes a practice, we will do everything we can to make that happen," Schone said. "But [directly employing physicians] is an advantage to the hospital. You have more control over fulfilling manpower needs. When you have a broad array of practices, you can respond to shortages in each. It creates an alignment of goals."

Kiernan said employing physicians directly at smaller satellite practices also has advantages for the patients.

"It provides a large group of physicians and a seamlessness of care," Kiernan said. "If your doctor is ill the day you have an appointment, someone can still take care of you. And with the electronic medical records, they have your history right in front of them."

Hospitals surveyed said the biggest challenge to recruiting physicians are geographic location and the lack of qualified candidates. Also, signing bonuses are increasing, and competitive pay, benefits, malpractice coverage and providing mid-level practitioners are among the most successful retention strategies.

Kiernan said Fulton County's geographic location has had a positive effect on recruitment at Littauer.

"We're close enough to the Capital Region that physicians and their families can have a very robust life and can still bring their experience and expertise to the residents of Fulton County," she said.

Adding to the shortage, the report says, is the age of physicians in New York. Of the approximately 59,000 active full-time equivalent doctors in the state, 16 percent are older than 65.

Schone said it takes about 12 to 15 years to train a doctor and there has been talk of increasing the size of medical schools next year, but the medical community won't receive those doctors for more than a decade.

"If this group of baby boomers retires, I don't think we can train people fast enough," he said.

That number is more than 20 percent in Fulton County, and recruitment can be curtailed by retirements. Kiernan said Littauer just completed a five-year plan and can see the retirements that could be coming five years from now.

"We need to be prepared for that," she said. "Most will be in the primary care areas, but we're already planning for it."

Kiernan said the best way to be ready for new physicians is to make sure they have all the tools necessary to do their jobs, which means keeping the technology up to date.

"While we recognize a shortage out there that seems to be gathering momentum, at this point, we're still filling positions," Kiernan said. "I think patients around here can feel secure that we're bringing in the best possible doctors to meet their medical needs."